Less invasive drug delivery shifts economic and social value in Parkinson’s disease

Pharma News: A less invasive treatment for Parkinson’s disease promises both economic and social value for patients and their caregivers.

Parkinson’s disease, affecting over 80,000 Australians, is a progressive neurodegenerative disorder marked by debilitating symptoms that worsen over time. While levodopa has long been the primary oral medication for managing symptoms, its efficacy diminishes as the disease advances, leading to unpredictable “off times” when symptoms are poorly controlled.

Device-assisted therapies (DATs) have emerged as an alternative, providing continuous administration of medicines to reduce symptoms. These therapies include subcutaneous apomorphine infusion, levodopa-carbidopa intestinal gel, and deep brain stimulation. However, the methods of medication delivery do not always suit the patient needs.

In a recent study led by the Royal Adelaide Hospital (RAH) and funded by AbbVie, researchers investigated a novel method of delivering Duodopa (levodopa), involving continuous 24-hour infusion into the skin. The results were promising: after 12 weeks of treatment, patients using the skin infusion method experienced nearly two hours less “off time” per day compared to those on oral levodopa, along with almost two hours more “on time” without troublesome involuntary movements.

Associate Professor Thomas Kimber, head of the movement disorders clinical trial program at the RAH, emphasised the significance of these findings.

“We are able to say that in patients who are inadequately controlled on their current medications and experiencing more than 2.5 hours of “off time” per day, subcutaneous infusion is more effective than optimally-dosed oral levodopa. It’s still demanding for patients, having an infusion for 24 hours per day, but it’s certainly effective – and more effective than oral levodopa alone,” he explained.

However, the study also noted more frequent non-serious adverse events in the infusion group, such as skin irritation, leading to a higher discontinuation rate compared to the oral group. Despite this, Professor Kimber highlighted the relative safety of the subcutaneous infusion method.

“Compared to surgery, a subcutaneous infusion has relatively low upfront risks, so for those it doesn’t work out for, it’s fairly easy to discontinue and switch to a different treatment option. This could be a significant advance; something new that we could offer patients instead of either oral levodopa or another device-assisted therapy,” said A/Professor Kimber.

The economic and social benefits of this device-assisted therapy extends beyond individual patients, as demonstrated by a Social Return on Investment (SROI) analysis also funded by AbbVie. For every dollar invested in expanding access to device-assisted therapies, $1.79 of economic and social value was generated over three years.

Professor George Mellick, Chair of Parkinson’s Australia, underscored the broader societal impact.

“We have known for a long-time that suitable care and treatment will help keep those with advanced disease out of hospitals and residential care. This study helps quantify the gains created by access to treatments and most importantly the positive impact on partners and families,” he commented.

Indeed, the study revealed that partners and families of patients realised over $237.3 million in social and economic gains over a three-year period, surpassing the gains for patients themselves. The outcomes included increased carer wellbeing, an ability to remain in the workforce and improvements in hope.

Despite the clear benefits, barriers to accessing these therapies persist, including patient hesitation, clinic capacity constraints, and limited services, particularly in rural areas.

Dr Sam Heshmat, Medical Director of Neurology & Parkinson’s Disease Specialist at Gold Coast Health and Hospital Services, stressed the urgency of addressing these barriers.

“With a rapid rise in Parkinson’s disease and associated costs with the ageing population there is an urgent need to review management strategies and access to treatments importantly for disease progression. Adopting measures we have at our disposal, that can bring gains for all affected must be a priority,” he asserted.

In light of these findings, stakeholders are calling for greater recognition of the multifaceted challenges posed by advanced Parkinson’s disease and increased investment in comprehensive care and support services.

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